Dombi: New Home Health Rule Has Some Positives

WASHINGTON, D.C. (November 5, 2021)—Home health agencies dodged a bullet when it came to the federal governemnt’s new rule on home health care, said National Association for HomeCare and Hospice (NAHC) President Bill Dombi.

That’s because the Centers for Medicare & Medicaid Services (CMS) did not end up requiring spending cuts to achieve budget neutrality in the final Home Health Rule it issued this week—despite suggesting it would in the draft.

“The CMS model concluded that the spending in 2022 would have exceeded budget neutrality by 6%,” Dombi said Friday on a NAHC webinar to dive into the rule. “If they had tied that into rulemaking, that would have meant a 6% reduction in pament rates in 2022, and more likely than not leading to further reductions in later years as well.”

Instead, the final rule came up with an across-the-board rate increase of 3.2%, and Dombi said there’s now time before the 2023 rule comes out to work with CMS to come up with a new methodology—which he called “an absolute total positive.”

In addition, the shift from draft to final indicates that the agency seems willing to listen to input when it comes to moving forward.

“We do believe the door is open to constructive conversations with CMS,” Dombi said.

Dombi said the agency’s decision to expand the Home Health Value-Based Purchasing Program (HHVBPP) from nine states to all of them is also positive—but so is the fact that CMS agreed to wait a year to put it into effect. It will kick in Jan. 1, 2023, making 2022 a “dry run” for agencies to practice reporting.

“We told (the Department of Health and Human Services) that we support the expansion mainly because it establishes what we’ve known for a long time but not everyone recognizes, namely that home health brings a dynamic value to the Medicare program,” Dombi said.

Other things that Dombi and NAHC Vice President of Regulatory Affairs Mary Carr noted in the new rule:

• CMS’s assumption that providers would have a 34% margin when it comes to the case-mix weight recalibration is “laughable,” he said, especially since telehealth and personal protective equipment costs were not accounted for.
• Significant changes to the area wage index could hit some providers very hard and isn’t consistent with what’s happening for inpatient providers like hospitals; he cited as an example one New Jersey area that will experience a 20% wage drop.
• Under the new rule, one 14-day supervisory visit may be conducted virtually per patient in a 60-day period, but the agency will need to document why it was not done in person.